H & E Associates, LLC

H & E Associates, LLC Home Care Business Consulting specializing in licensure and Medicaid/Medicare accreditation for home care, home health, and private duty.

We would provide guidance throughout the licensure and/or accreditation process AND ensure your agency is well prepared to operate successfully in the industry.

Most agency owners sign MCO provider agreements without fully understanding what they are agreeing to. I understand why ...
06/18/2026

Most agency owners sign MCO provider agreements without fully understanding what they are agreeing to. I understand why — these documents are long, written in legal language, and you are usually eager to just get contracted.

But what is in that agreement will govern your entire relationship with that MCO. Here is how to read one properly.

Step 1: Find the termination clause.
Before anything else, understand how either party can end the relationship. Look for language about "without cause" termination — this is common, and it means the MCO can end your contract with as little as 30 or 60 days notice for any reason. Know this going in.

Step 2: Read the covered services section.
This tells you exactly which service codes you are authorized to bill under this agreement. Do not assume that because you are licensed to provide a service, the MCO will pay for it under this contract. If it is not listed, you cannot bill it.

Step 3: Understand the billing and payment terms.
Look for timely filing limits (usually 90 to 365 days from the date of service), claim submission requirements, and the dispute resolution process for denied claims. Missing a timely filing deadline means you eat that claim — no exceptions.

Step 4: Find the audit and record retention requirements.
Most agreements require you to retain records for 6 to 10 years and to make them available to the MCO or state agency on request. Understand what that means for your documentation practices.

Step 5: Look for the compliance requirements.
Many MCO agreements now require you to have a written compliance program, a code of conduct, and HIPAA policies in place. If you do not have these and you signed saying you do — that is an exposure.

Read it. All of it. Or have someone read it with you.

Have a provider agreement you need to review? Drop a comment or DM me. I do contract review as part of my consulting services.

Everyone focuses on the credentialing application. The paperwork, the enrollment, the waiting, the approval.And yes, tha...
06/17/2026

Everyone focuses on the credentialing application. The paperwork, the enrollment, the waiting, the approval.

And yes, that process is real and it matters and I have helped a lot of agencies get through it.

But here is what nobody tells you about what happens after you get approved:

MCOs re-credential you. Every two to three years, depending on the plan. And if you miss their recredentialing request — which often comes in as one letter to an address that may have changed, or an email that got buried — your contract gets terminated.

Quietly. Without a phone call. You find out when a claim gets denied.

Beyond recredentialing, MCOs also monitor your compliance status. Complaints filed against your agency. Survey deficiencies with the state. Licensing actions. Any of these can trigger a contract review or termination.

And then there is utilization. MCOs track whether you are actually serving members. If you are approved but dormant — no claims, no active clients under that plan — some plans will pull your contract to free up their network capacity.

Staying on a panel requires the same intentionality as getting on one:

Keep your contact information updated with every MCO you contract with. Calendar your recredentialing dates two months in advance. Submit claims consistently once you are approved. Keep your compliance record clean.

The agencies that build sustainable businesses treat their MCO relationships like business partnerships — not checkboxes they completed once and forgot about.

Do you know your recredentialing dates for each MCO you are contracted with? Drop a yes or no below.

Most people in this industry are isolated. They go to work, they handle the crises, they try to grow, and they have nobo...
06/16/2026

Most people in this industry are isolated. They go to work, they handle the crises, they try to grow, and they have nobody around them who understands what they are dealing with. No peer group. No one to call when the MCO sends a confusing denial letter or the state inspector shows up unannounced.

This community exists to change that.

If you are reading this and you have been lurking — not commenting, not engaging, just watching — I want you to know something.

The value you get from a community is directly proportional to what you put in. Not financially. In terms of presence.

The agency owners who grow the fastest are not the ones with the most money or the most connections. They are the ones who are willing to be honest about where they are, ask the questions they are afraid sound stupid, and actually implement what they learn.

This week, I want to challenge you: leave one comment, ask one question, or reply to one post you have been meaning to respond to.

That one action might be the thing that connects you to the person who changes the trajectory of your business.

Introduce yourself below if you have not already. Name, state, and what kind of agency you are building.

Most home care agencies billing Medicaid waiver services are leaving money on the table. Not because they are billing th...
06/15/2026

Most home care agencies billing Medicaid waiver services are leaving money on the table. Not because they are billing the wrong rate. Because they are miscounting units.

Here is the mistake: Medicaid waiver services — whether that is personal care, companion services, respite care — are typically billed in 15-minute units. Four units equals one hour.

Simple, right? Except here is where agencies get it wrong.

They bill based on the scheduled shift, not the documented time.

Your caregiver was scheduled for a 3-hour shift. She arrived 12 minutes late and the client cut the visit short by 20 minutes. The actual time of service was 2 hours and 28 minutes.

Your billing department submits 12 units (3 hours). The actual documented and defensible service was 9 units and change.

Over 200 visits a month, that gap compounds — but more importantly, that overbilling is a compliance violation. And when an MCO or DMAS does a post-payment audit, they are looking at exactly this.

The fix is not complicated:

1. Make sure your EVV system or caregiver documentation captures actual clock-in and clock-out times.

2. Bill based on actual documented time, rounded to the nearest unit per your provider agreement.

3. Review a random sample of 10 claims per month against your EVV data to check for drift.

This is not just about protecting yourself in an audit. It is about running a business with integrity — which is the only kind of business that lasts.

Are you using EVV? Are your billed units matching your documented time? Drop a yes or no in the comments.

We are one week in. Here is what I heard from you.The poll results from all of our platforms showed that credentialing a...
06/12/2026

We are one week in. Here is what I heard from you.

The poll results from all of our platforms showed that credentialing and contracts are the two biggest pain points in this community right now. Some of you are stuck in pending applications that have been sitting for months. Others are licensed and ready to serve clients but have no idea how to get in front of MCOs or government contracts.

I heard you. And that is exactly where we are going next week.

A few things that stood out from the comments this week:

Several of you have been operating for over a year and are still not on a single MCO panel. That is not your fault — but it is fixable, and we are going to fix it.

Some of you shared that you built your policies from templates and have not been back to review them since. That is a compliance liability sitting in your file cabinet. We are going to address that.

And one of you said something that stuck with me: "I did not realize I could ask for help with this stuff. I thought I just had to figure it out."

That is exactly the wrong message you should be getting. This industry is complicated on purpose — these systems are not designed to be easy to navigate. You are supposed to need support. The agencies that grow are the ones that get it.

Here is what is coming in Week 2:

Monday — The single mistake that keeps most home care agencies off MCO panels for months

Wednesday — A step-by-step walkthrough of how to read your provider agreement before you sign

Friday — A live Q&A at 3pm ET. Drop your questions in the comments now so I can prepare.

Not the surface answer. Not "the market was tough" or "I ran out of money."The real reason.Would it be that you spent to...
06/10/2026

Not the surface answer. Not "the market was tough" or "I ran out of money."

The real reason.

Would it be that you spent too long operating without a compliance foundation and a deficiency finally caught up with you?

Would it be that you could never get past word-of-mouth referrals because you had no credentialing strategy?

Would it be that you hired people before you had systems, and the business became impossible to manage?

Would it be that you never asked for help because you did not want to look like you did not know what you were doing?

I ask this not to be heavy — but because the agency owners who build something lasting are the ones willing to look directly at their vulnerabilities before those vulnerabilities become crises.

The ones who think "that could never happen to me" are often the ones it happens to.

So what is yours? What is the thing in your business right now that, left unaddressed, could cost you everything?

You do not have to share it publicly. But sit with the question.

And if you do want to share it here — this is a safe space. No judgment. Just people who are building alongside you.

Drop a comment. What is the real risk in your agency right now?

I am not going to use her name, but she is a home care agency owner right here in the DMV.She had done everything she th...
06/09/2026

I am not going to use her name, but she is a home care agency owner right here in the DMV.

She had done everything she thought was right. Got her license. Hired staff. Built her policies. Applied to three MCOs.

Six months later — not one approval. The phone was not ringing. The money was not coming in. And she was starting to wonder if she had made a mistake going into business.

When she came to me, the first thing I asked her was: "Can I see your credentialing applications?"

Within twenty minutes I spotted it. She had applied under the wrong provider type on two of the three applications. She was licensed as a Residential Service Agency, but she had checked the wrong box on the MCO enrollment form — one that was meant for skilled nursing facilities.

The applications had been sitting in a review queue for months because the classification did not match her licensure.

We corrected the provider type, resubmitted with a cover letter explaining the correction, and added supporting documentation to make the reviewer's job easy.

She was approved by two MCOs within 45 days.

The problem was never her agency. It was one checkbox.

This is why credentialing support matters. Not because you are not capable — but because these systems are designed for people who do them every day, not people building a business for the first time.

If you are sitting on a pending application or wondering why you have not heard back — drop a comment or DM me. There is often a simple fix.

I have reviewed dozens of provider applications. The single most common reason for MCO credentialing delays is not missi...
06/08/2026

I have reviewed dozens of provider applications. The single most common reason for MCO credentialing delays is not missing paperwork.

It is mismatched information.

Here is exactly what I mean:

Your NPI record says your practice address is 1234 Main St, Suite A. Your state license has 1234 Main Street. Your W-9 shows 1234 Main St with no suite number.

Those are three different addresses to a credentialing system. And the application gets kicked back, flagged, or held — sometimes for weeks — while someone tries to reconcile them manually.

Before you submit anything to an MCO, do this:

Pull your NPI record at nppes.cms.hhs.gov. Pull your state license. Pull your W-9. Pull your certificate of insurance. Lay them side by side and make sure every single address, legal entity name, and tax ID is character-for-character identical across all four.

This check takes less than 10 minutes. It can save you 6 to 8 weeks of delays.

I have seen agencies in Virginia, Maryland, and DC lose entire contracting cycles because of this. Do not let that be you.

Fix it before you submit. Always.

Home care referrals do not only come from case managers. Many valuable partners influence families before a crisis happe...
05/27/2026

Home care referrals do not only come from case managers. Many valuable partners influence families before a crisis happens.

Elder law attorneys often guide families through long-term care planning, Medicaid questions, and aging-in-place decisions. Geriatric care managers help families coordinate support, monitor changes, and choose trusted providers. Senior living directors may meet residents who need extra one-on-one help to remain safe and comfortable. Hospice and palliative care teams often support families who need caregiver relief and non-medical assistance at home. Physicians, pharmacists, social workers, faith leaders, and community organizations may also notice when an older adult is struggling with meals, mobility, transportation, or personal care.

The key is to build relationships before asking for referrals. Offer education, be responsive, and show how your agency makes their work easier. A strong referral network is not built around one title. It is built around people who care about helping families find the right support.

Enlist your agency to be included as a provider to receive referrals from the Community Care Hub.
https://f.mtr.cool/bwediecimq

05/21/2026

Why you should be nowhere but Silver Spring Civic Building on May 19, 2026

Calling on ALL home and community based service providers (home health care, group homes, hospice, ALFs, NEMTs, EMS agencies) to be in the room.








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1765 Greensboro Station Place Ste 900
McLean, VA
22102

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Tuesday 9am - 5pm
Wednesday 9am - 5pm
Thursday 9am - 5pm
Friday 9am - 5pm

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